1. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” Maternal Mortgage An Analysis of Trans-Generational Health Consequences José C. Lacal J.Lacal@UMiami.edu

2. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” Contents  Definitions and Bias  Health Index Through Life-cycle  Maternal Choices: Alcohol Abuse, Dependence Smoking Nutrition and Obesity  Maternal Mortgage Model  Conclusions

3. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” Definitions “Weathering:” theoretical framework of how race, ethnicity, and SES affect health and where life circumstances affect health differentially as an individual ages. Life-course Socioeconomic Deprivation: “Diseases are multifactorial, as a result of interaction between individual’s genetic makeup, health behaviors, strongly patterned by one’s access to both individual and neighborhood-level socioeconomic resources over the entire life course.”

4. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” My Bias  Demography is Destiny  People make daily choices, and draw consequences  Society pays for everybody’s bad personal choices

5. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” Health Index Through Life-cycle Model

6. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” Health Index Through Life-cycle Model

7. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” Health Index Through Life-cycle Model

8. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” Health Index Through Life-cycle Model

9. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” Maternal Choices **  Alcohol Abuse, Dependence  Smoking  Nutrition and Obesity ** : The use of “choice” is to indicate that personal and social factors, in varying degrees of influence, lead to these behaviors. These factors can be addressed, if society and individuals so choose.

10. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” Alcohol Abuse, Dependence Two most prevalent and deleterious psychiatric disorders not only in the United States but in the world. I992: 14 million adults in the United States abused alcohol or were dependent on it. Evidence that both genetic and environmental exposure to alcoholism predispose children to become alcoholics themselves. Evidence from studies of environmental exposure that children of alcoholic parents are at risk. 25% children under 18 years in US are exposed to alcohol abuse or alcohol dependence in the family. Many studies have shown as well that parental alcoholism is associated with a range of psychopathology and other behavioral and medical problems in offspring, including conduct disorder and delinquency, use and abuse of alcohol and other drugs in adolescence, anxiety disorders, and impaired physical health.

11. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” Maternal Smoking During Pregnancy  Research suggests that in utero exposure to maternal smoking is a risk factor for conduct disorder and delinquency.  Analysis of maternal prenatal smoking and offspring antisocial behavior within a causal framework.  The association is (1) independent of confounders, (2) present across diverse contexts, and (3) consistent with basic science. Methodological limitations of existing studies preclude causal conclusions.  Existing evidence provides consistent support for, but not proof of, an etiologic role for prenatal smoking in the onset of antisocial behavior.  Smoking during pregnancy represents a major public health problem. 50% women who smoke continue to do so throughout their pregnancies.  US: over 0.5M infants per year are prenatally exposed to maternal smoking.  It has long been established that maternal smoking during pregnancy has adverse perinatal consequences. Newer evidence suggests that it may have consequences that extend far beyond the perinatal period.  Smoking as a confounder?

12. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” Nutrition and Obesity  "Fetal Origins of Disease Hypothesis:" susceptibility to adulthood cardiovascular disease (CVD), non-insulin- dependent diabetes mellitus (NIDDM), and the insulin resistance syndrome (IRS) is programmed in utero and is a response to fetal under-nutrition. The hypothesis is also referred to as the thrifty phenotype hypothesis.  Numerous studies: inverse relationship between markers of fetal growth and the later development of cardiovascular disease and the IRS.  Animal studies provide the best evidence to date. In rats, protein restrictive diets during pregnancy led to lower birth weight offspring and to higher blood pressure and reduced insulin secretion in adulthood.  These studies provide the best evidence that maternal nutrition can program the offspring physiologically in such a way as to influence disease susceptibility in adulthood.  SES as a confounder?

13. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” Maternal Mortgage Model - 01  Life-course Socioeconomic Deprivation

14. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” Maternal Mortgage Model - 02  Impact of maternal choices during pregnancy

15. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” Maternal Mortgage Model - 03  “Life-course health policy:” Many common chronic and mental disorders have modifiable precursors that arise during childhood. This model of how health is produced provides a scientific basis for understanding the continuity between child and adult health.  The model seeks to promote the well-being of the young, both because of its intrinsic value and because doing so will improve the health of the population at all ages. It mandates increased attention to the promotion of biopsychosocial adaptability and other approaches to preventing the precursors to future disorders. Finally, it requires health policies to foster positive long-term outcomes focused on the individual, family, and community.

16. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” Maternal Mortgage Model - 04 1960 1980 2000

17. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” Conclusions, Recommendations It’s all about economics:  Gradient of health / wealth: APHA’s 200020 Goal: Raising Income to Protect Health  Prevention is not privately profitable Risks at Both Ends  Teenage Mothers  Late Deliveries Multiple births Future impact of ART Given that pre-conceptional health care can improve outcomes, that the early phases of conception are crucial for the fetus’s development, that any delay in ascertaining pregnancy status could lead to a late start in taking nutritional measures, and that over 50% of pregnancies are unexpected, all females (regardless of age) must be offered pre- conceptional services almost from birth in order to minimize negative impacts on their children.

18. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” Future Research Maternal Mortgage Economic Model: Create a predictive model to track: * teenage unmarried low SES woman => odds child with: pre-term; LBW ==> teeenage mother herself ===> child with same (or worse) odds than mother

19. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” Thank You Remember, that the human being is the most important of all products to turn out. I am eagerly anxious to do everything I can to wake up our people to the need of protecting the soil, protecting the forests, protecting the water; but first and foremost, protect the people. If you do not have the right kind of citizens in the future, you cannot make any use of the natural resources. Protect the children - protect the boys; still more, protect the girls. Because the greatest duty of this generation is to see to it that the next generation is of the proper kind to continue the work of this nation. (President Theodore Roosevelt, 1911).

20. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” Contact Information  This file (and all supporting data) available at http://lacal.net/PH.html  Revised versions updated monthly. Related work (“Public Health Futures” economic model):  Session 5112 (Room 105) at 13:20 hr. J.Lacal@UMiami.edu

21. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” BACKUP

22. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” Learning Objectives 1. Articulate how social, economic, environmental, nutritional, educational and other conditions in the life of a female have a clear and discernible impact on the health and well-being of an infant and later in life.; 2. Construct a graphical representation of those impacts that includes relevant theories and research linking conditions to consequences.; and 3. Develop the ability to conduct a public discussion on the long-term social and economic impact of failing to address those pre-conception conditions.

23. © 2006 José C. Lacalhttp://lacal.net/PH.html“Maternal Mortgage.” Disclosures  MPH candidate at U. Miami (FL).  Don’t speak for current employer. Maternal Mortgage concept:  I developed idea; may be old hat.  Will expand for capstone project. Comments, suggestions welcome.